. Gynecology : . n cancer of the vulva is that recommendedby Taussig. He divides the operation into two stages, the first being a dissectionof the two inguinal regions, and the second, performed sometime later, a removal OPERATIONS ON THE VULVA 585 of the primary cancer mass. The two-stage operation is especially advisable be-cause it is impossible to secure first intention healing from the vulvectomy wound,and if the inguinal regions have been dissected at the same time they are almostsure to be infected from the vulvar area. This results in an enormous gapingwound which requires weeks of gra
. Gynecology : . n cancer of the vulva is that recommendedby Taussig. He divides the operation into two stages, the first being a dissectionof the two inguinal regions, and the second, performed sometime later, a removal OPERATIONS ON THE VULVA 585 of the primary cancer mass. The two-stage operation is especially advisable be-cause it is impossible to secure first intention healing from the vulvectomy wound,and if the inguinal regions have been dissected at the same time they are almostsure to be infected from the vulvar area. This results in an enormous gapingwound which requires weeks of granulation and slow healing. The dissection of the inguinal regions is carried out by the Basset long inguinal incision is made as in an operation for inguinal hernia, the inci-sion being carried somewhat further toward the vulva so as to allow for wideretraction of the skin. The aponeurosis of the external oblique is divided as ina hernia operation and the round ligament exposed from the external to the. Fig. 215.—Dissection of the Inguinal Region foe Cancer of the round ligament is being freed, with glandular and fatty tissue attached. internal ring. The ligament is lifted out of its bed, care being taken that asmuch of the surrounding fatty and cellular tissue shall adhere to it as possible,for in this are contained the lymphatics of the so-called upper pedicle. When the ligament has been freed to the internal ring one sees at this pointthe epigastric artery and vein. The small peritoneal culdesac which surroundsthe round ligament at its entrance into the peritoneal cavity is now opening the peritoneum a retractor is inserted into this culdesac anddrawn strongly upward, as in Fig. 215. This exposes the anterior part of theinternal iliac fossa. All the glandular and cellular fatty tissue is then dissectedaway from the iliac vessels. Returning now to the inner end of the round liga- 586 GYNECOLOGY ment (i. e., at the external inguinal ring) the
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